Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), .
Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Nat Med. 2020 Aug;26(8):1295-1306. doi: 10.1038/s41591-020-0939-8. Epub 2020 Jun 29.
Immune-regulatory mechanisms of drug-free remission in rheumatoid arthritis (RA) are unknown. We hypothesized that synovial tissue macrophages (STM), which persist in remission, contribute to joint homeostasis. We used single-cell transcriptomics to profile 32,000 STMs and identified phenotypic changes in patients with early/active RA, treatment-refractory/active RA and RA in sustained remission. Each clinical state was characterized by different frequencies of nine discrete phenotypic clusters within four distinct STM subpopulations with diverse homeostatic, regulatory and inflammatory functions. This cellular atlas, combined with deep-phenotypic, spatial and functional analyses of synovial biopsy fluorescent activated cell sorted STMs, revealed two STM subpopulations (MerTKTREM2 and MerTKLYVE1) with unique remission transcriptomic signatures enriched in negative regulators of inflammation. These STMs were potent producers of inflammation-resolving lipid mediators and induced the repair response of synovial fibroblasts in vitro. A low proportion of MerTK STMs in remission was associated with increased risk of disease flare after treatment cessation. Therapeutic modulation of MerTK STM subpopulations could therefore be a potential treatment strategy for RA.
类风湿关节炎(RA)无药物缓解的免疫调节机制尚不清楚。我们假设,在缓解期持续存在的滑膜组织巨噬细胞(STM)有助于关节的稳态。我们使用单细胞转录组学对 32000 个 STM 进行了分析,并在早期/活动期 RA、治疗抵抗/活动期 RA 和持续缓解的 RA 患者中鉴定了表型变化。每个临床状态的特点是在四个不同的 STM 亚群内存在不同频率的九个离散表型簇,这些亚群具有不同的稳态、调节和炎症功能。这个细胞图谱,结合滑膜活检荧光激活细胞分选 STM 的深度表型、空间和功能分析,揭示了两个具有独特缓解转录组特征的 STM 亚群(MerTKTREM2 和 MerTKLYVE1),其富含炎症负调节因子。这些 STM 是炎症消退脂质介质的有效产生者,并在体外诱导滑膜成纤维细胞的修复反应。缓解期 MerTK STM 的低比例与治疗停止后疾病复发的风险增加有关。因此,调节 MerTK STM 亚群可能是 RA 的一种潜在治疗策略。
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